Coccygeal Pain

Dr. Reeves' Notes: This study related to chronic pain in coccyx (coccygodynia) after coccyx fracture. Treatment of coccygodynia after fracture was the subject of a consecutive patient study recently published in the Journal of Orthopedic Surgery. 30 out of 37 patients with chronic non-responding coccygodynia responded to 2 injections of 20% dextrose. The recommendation was a trial of dextrose prolotherapy prior to proceeding to coccygectomy. However the time period of follow-up was not clear in this article.

A copy of the complete study on coccygeal pain is available in PDF format here.

An abstract of the study on coccygeal pain is available here, with a copy of the content below...

PURPOSE. To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients.

METHODS. 14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later.

RESULTS. The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief.

CONCLUSION. Dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomized studies are needed to compare prolotherapy with local steroid injections or coccygectomies. Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.